HomeMy WebLinkAboutBy-law No. 2007-123 CORPORATION OF THE
MUNICIPALITY OF BAYHAM
BY-LAW NO.2007-123
BEING A BY-LAW TO AUTHORIZE THE EXECUTION OF AN
AGREEMENT BETWEEN THE MUNICIPALITY AND MINISTRY
OF HEALTH AND LONG-TERM CARE
WHEREAS the Municipality of Bayham has applied to the Ministry of Health and Long-Term
Care under the "Grow Your Own NP Initiative" for funding support for the position of Nurse
Practitioner;
AND WHEREAS it is deemed necessary to enter into an Agreement with the Ministry of Health
and Long-Term Care for the provision of funding support under the "Grow Your Own NP
Initiative"Program to the Municipality of Bayham.
THEREFORE THE COUNCIL OF THE CORPORATION OF THE MUNICIPALITY OF
BAYHAM ENACTS AS FOLLOWS.
1. THAT the execution of an Agreement with the Ministry of Health and Long-Term Care
under the"Grow Your Own NP Initiative"be and the same is hereby authorized.
2. THAT this by-law shall come into full force and effect upon final passing.
READ A FIRST, SECOND AND THIRD TIME AND FINALLY PASSED this 20th day of
December 2007.
elan /U1 L.IMAYO RK
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nta r i o
and Long-Term Care et des Soins de longue duree C7S7
Primary Health Care Renouvellement des coins primaires
Primary Health Care and Equipe de renouvellement des coins
Famiry Health Teams primaires et equipes Sante familiale
Health System Accountability Division de la responsabilisation et de
and Performance Division la performance du systOme de sante
80 Queen Street,3rd Floor 80,rue Queen,3e r tage
Kingston ON K7K 6W7 Kingston ON K7K 6W7
Tel: 613 650-5444 Tel.: 613 650-5444
Fax: 613 650-5440 Telec: 613 650-5440
January 14, 2008
Municipality of Bayham
9344 Plank Road
Straffordville ON NOJ 1Y0
Attention: Margaret Underhill, Planning Coordinator-Deputy Clerk
Dear Ms. Underhill:
Re: Nurse Practitioner Funding Agreement under the Grow Your Own Nurse
Practitioner ("GYONP") Initiative — Municipality of Bayham ("Organization")
EIgi104
The Ministry entered into an agreement with the Organization dated September 1, 2006
to facilitate the education of a nurse practitioner (the "GYONP Agreement"), attached to
this Agreement as Schedule "E".
Pursuant to the GYONP Agreement, the Ministry, the Organization and the Nurse
Practitioner entered into a Return of Service Agreement (the "ROS Agreement"),
attached to this Agreement as Schedule "F", whereby the Nurse Practitioner agreed to
provide Services for the Organization for a two-year period following her registration as
a nurse practitioner.
This letter sets out the terms and conditions governing the funds the Ministry shall
provide to the Organization for the Nurse Practitioner's Services for the term of the ROS
Agreement.
Definitions
1 . In this Agreement, the following words shall have the following meanings:
"Agreement" means this agreement between the Ministry and the Organization,
all schedules attached to this Agreement and any instrument amending this
Agreement.
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Municipality of Bayham
"Budget" means the budget attached as Schedule "B"
"CNO" means the College of Nurses of Ontario.
"Collaborating Physician" means the physician with whom the Nurse
Practitioner enters into an agreement pursuant to subsection 9(d).
"Fiscal Period" means:
(a) in the case of the first Fiscal Period, the period commencing November 1,
2007 and ending on the first day that is March 31 following the date of this
Agreement; and
(b) in the case of Fiscal Periods subsequent to the first Fiscal Period, the
period commencing on the date that is April 1 following the end of the
previous Fiscal Period and ending the following March 31
"Funds" means the funds described in section 3.
"Ministry" means the Ministry of Health and Long-Term Care.
"Nurse Practitioner" means Kristal Pitter RN(EC).
"Nurse Practitioner Records" means all records and documents created by the
Nurse Practitioner in providing the Services.
"Nursing Act" means the Nursing Act, 1991, S.O. 1991, c. 32.
"Organization" means the Municipality of Bayham.
"Organization Records" means all records, invoices and other documents
created by or belonging to the Organization that relate to the Funds and the
operation of the Program.
"Program" means the program described in section 8 of this Agreement.
"Resident" has the meaning ascribed to in the Health Insurance Act, R.S.O,
1990, c. H.B.
"Service Area" means in the Municipality of Bayham.
"Services" means primary health care services that the Nurse Practitioner is
authorized by law to perform.
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Municipality of Bayham
Term
2. This Agreement shall commence on November 1, 2007 and shall end on October
30, 2009 unless terminated earlier pursuant to section 21, 22 or 24 of this
Agreement.
The Funds
3. Subject to section 27, the Ministry shall, in each Fiscal Period provide to the
Organization the Funds specified in the Budget for the provision of Services.
Based upon the reports provided to the Ministry pursuant to section 16, the
Ministry shall, for each Fiscal Period, subsequent to the first Fiscal Period,
approve a budget that shall be deemed:
(a) to be the Budget in respect of the succeeding Fiscal Period to which it
relates;
(b) to replace the Budget for the prior Fiscal Period; and
(c) to form Schedule "B" to this Agreement.
4. The Ministry shall make payments to the Organization in monthly instalments:
(a) in the amount listed in the Budget;
(b) by direct deposit into a bank account designated by the Organization; and
(c) on the last business day of each month.
5. If the Nurse Practitioner does not begin work on the first business day of the
month, the Ministry shall prorate the first payment to reflect the time the Nurse
Practitioner worked during the first month.
6. The Organization shall only use the Funds to operate the Program in accordance
with this Agreement and shall expend the Funds only in accordance with the
Budget.
7 The Organization shall not move Funds from one Budget category to another
without the prior written consent of the Ministry.
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Municipality of Bavham
The Program
8. The Organization shall operate a Program for the provision of primary care
services that ensures that Residents of the Service Area, who are patients of the
Organization, receive the Services of the Nurse Practitioner on a full-time basis
(where full-time is interpreted to mean a minimum of 35 hours per week,
exclusive of absence due to vacation, sickness and other reasons for absence
that are reasonably deemed acceptable by the Organization), at times that are
commensurate with the needs of the community in the Service Area.
9. In operating the Program, the Organization shall:
(a) engage the services of the Nurse Practitioner to provide the Services;
(b) ensure that the Nurse Practitioner is, and continues to be for the duration
of the Agreement, a member of the CNO who holds an extended
certificate of registration under the Nursing Act;
(c) ensure that the Nurse Practitioner maintains for the period during which
the Nurse Practitioner provides Services, malpractice protection in the
amount of not less than $5,000,000 on an occurrence basis;
(d) ensure that the Nurse Practitioner enters into an agreement with a
Collaborating Physician for the period during which the Nurse Practitioner
provides Services, for the purposes of, and to cover the matters outlined
in, Schedule "A";
(e) use its best efforts to ensure that the Nurse Practitioner:
(i) only provides Services for the benefit of Residents;
(ii) does not charge any Resident any fee for any Service;
(iii) meets the Nurse Practitioner's professional obligations as
described in the Standards for Consultation. with Physicians by
RNECs, issued by the CNO;
(iv) provides all Services in compliance with all federal, provincial and
municipal laws and regulations, and any orders, rules and by-laws
related to any aspect of the Services;
(v) keeps and maintains all Nurse Practitioner Records in a manner
consistent with generally accepted accounting principles or clerical
practices, as the case may be;
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Municipality of Barham
(vi) maintains all Nurse Practitioner Records and keeps them available
for review by the Organization and the Ministry for a period of
seven (7) years from the date of the termination or expiry of this
Agreement; and
(vii) maintains all Nurse Practitioner Records that contain personal
information about the people to whom the Nurse Practitioner
provides Services, in a confidential manner consistent with all
applicable laws;
(f) continue to contribute to the operation of the Program for the period during
which this Agreement is in effect, which contribution shall be satisfactory
to the Ministry;
(g) keep and maintain all Organization Records in a manner consistent with
generally accepted accounting principles or clerical practices, as the case
may be;
(h) maintain all Organization Records and keep them available for review by
the Ministry for a period of seven (7) years from the date of the termination
or expiry of this Agreement;
(i) allow the Ministry, upon twenty-four (24) hours' notice and during normal
business hours, to enter upon the Organization's premises to inspect and
copy any Organization's Records in the possession or under the control of
the Organization which relate to the Funds; and
(j) acquire all equipment, supplies and services (other than Services) it
purchases with the Funds through a process that ensures the best value
for funds expended.
Additional Terms and Conditions
10. The Ministry shall be entitled, at any time, to impose such additional terms or
conditions on the Organization that it considers appropriate for the proper
expenditure and management of the Funds and the operation of the Program.
Inspection and Audit
11 . The Ministry's right of inspection in this Agreement includes the right to perform
an audit of any kind including a review or examination of any aspect of the
Program or the Services or any Organization Records.
12. To assist the Ministry to carry out its inspection under this Agreement, the
Organization shall provide any other information to the Ministry reasonably
requested by the Ministry.
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Municipality of Bayham
13. The purposes for which the Ministry may exercise its inspection and audit rights
include:
(a) determining for what items and purposes the Organization is expending or
has expended the Funds; and
(b) determining whether the Organization is operating the Program effectively
and in accordance with the terms of this Agreement.
14. Nothing in this Agreement shall require the Organization, except as otherwise
permitted or required by law, to disclose any personal information, or any
personal health information or records to the Ministry.
15. No right conferred upon the Ministry under the Agreement nor any provision of
the Agreement shall be construed so as to give the Ministry any control
whatsoever over the Organization Records or the Nurse Practitioner Records.
Reports
16. The Organization shall submit to the Ministry the reports listed in Schedules "C"
and "D", on the dates listed in Schedules "C" and "D", and such other reports as
the Ministry may request from time to time.
17. The Organization shall ensure that all reports are in a form satisfactory to the
Ministry.
Indemnification
18. The Organization shall indemnify and hold harmless the Ministry, its officers,
employees and agents for any incidental, indirect, special or consequential
damages, or any loss of use, revenue or profit, by any person, entity or
organization including the Organization, arising out of or in any way related to
this Agreement.
Insurance
19. The Organization shall put into effect and maintain for the period during which
the Agreement is in effect, at its own expense, all the necessary insurance that
would be considered appropriate for an organization operating a Program of this
kind, including:
(a) Commercial General Liability Insurance, to an inclusive limit of not less
than Two Million Dollars ($2,000,000) per occurrence for property
damage, bodily injury and personal injury, and including, at least, the
following policy endorsements:
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Municipality of Bayham
(i) Her Majesty the Queen in right of Ontario as represented by the
Ministry of Health and Long-Term Care, as an additional insured
with respect to the operation of the Program provided and the
provision of Services under this Agreement;
(ii) a cross-liability clause endorsement;
(iii) a contractual liability endorsement; and
(iv) a 30 day written notice of cancellation.
20. Upon request of the Ministry, the Organization shall provide the Ministry with
proof of insurance.
Termination
21. Either party, at any time, without reason and without liability, cost or penalty, may
terminate this Agreement upon giving 90 days' written notice to the other party.
22. The Ministry may, in its sole discretion, without liability, cost or penalty, and without
prejudice to any other rights or remedies of the Ministry under this Agreement, any
other agreement, at law or in equity, terminate this Agreement immediately upon
giving written notice to the Organization if:
(a) in the opinion of the Ministry:
(i) the Organization breaches any term or condition of this Agreement;
(ii) the Organization is unable to operate the Program;
(iii) the Organization enters into another agreement with the Ministry
for the same or similar purposes;
(iv) the ROS Agreement is terminated;
(v) the Organization breaches any term or condition of either the
GYONP Agreement or the ROS Agreement;
(vi) the Nurse Practitioner breaches any term or condition of the ROS
Agreement; or
(vii) the Nurse Practitioner ceases to provide Services for the
Organization in accordance with the terms of the ROS Agreement;
or if:
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Municipality of Bayham
(b) the Organization makes an assignment, proposal, compromise, or
arrangement for the benefit of creditors, or is petitioned into bankruptcy, or
files for the appointment of a receiver; or
(c) the Organization ceases to operate.
23. If the Ministry, in its sole discretion, considers the nature of the breach referred to
in section 22(a)(i), section 22(a)(v) or section 22(a)(vi) to be such that it can be
remedied and that it is appropriate to allow the Organization the opportunity to
remedy the breach, the Ministry may give the Organization an opportunity to
remedy the breach by giving the Organization written notice:
(a) of the particulars of the breach;
(b) of the period of time within which the Organization is required to remedy
the breach; and
(c) that the Ministry shall terminate this Agreement:
(i) at the end of the notice period provided for in the notice if the
Organization fails to remedy the breach within the time specified in
the notice; or
(ii) prior to the end of the notice period provided for in the notice if it
becomes apparent to the Ministry that the Organization cannot
completely remedy the breach within that time or such further
period of time as the Ministry considers reasonable, or the
Organization is not proceeding to remedy the breach in a way that
is satisfactory to the Ministry.
24. If the Ministry has provided the Organization with an opportunity to remedy the
breach, and:
(a) the Organization does not remedy the breach within the time period
specified in the notice;
(b) it becomes apparent to the Ministry that the Organization cannot
completely remedy the breach within the time specified in the notice or
such further period of time as the Ministry considers reasonable; or
(c) the Organization is not proceeding to remedy the breach in a way that is
satisfactory to the Ministry,
the Ministry shall have the right to immediately terminate this Agreement by
giving notice of termination to the Organization.
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Municipality of Bayham
25. In the event of termination pursuant to section 24, the effective date of
termination shall be the last day of the notice period, the last day of any
subsequent notice period or immediately, which ever applies.
Suspension of Funding
26. Despite its right to terminate the Agreement pursuant to sections 21 , 22 and 24,
the Ministry may choose not to terminate the Agreement and may choose to
suspend Funding under the Agreement for such period as the Ministry
determines necessary and appropriate.
Funding Upon Termination
27. If this Agreement is terminated by the Ministry or the Organization (as the case
may be) pursuant to section 21, 22 or 24, the Ministry shall:
(a) cancel all further Funding instalments;
(b) demand the payment of any Funds remaining in the possession or under
the control of the Organization; and
(c) demand the payment of monies equal to any Funds uses uy the
Organization for purposes not agreed upon by the Ministry.
Funding at end of Fiscal Period and Upon Expiry
28. If, at the end of any Fiscal Period or upon the expiry of the Agreement:
(a) the Organization has not spent all of the Funds allocated as provided for in
the Budget; or
(b) the Organization has used Funds for purposes not agreed upon by the
Ministry,
the Ministry may demand the payment of the unspent Funds or monies equal to
any Funds used for purposes not agreed upon by the Ministry, and the
Organization shall pay them immediately to the Ministry.
Debts Owing to the Ministry
29. If the Ministry demands the payment of any Funds or monies pursuant to this
Agreement, the amount demanded shall be deemed to be a debt due and owing
to the Ministry and the Organization shall pay the amount to the Ministry
immediately unless the Ministry directs otherwise.
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Municipality of Bavham
30. The Ministry reserves the right to demand interest on any amount owing by the
Organization at the then current rate charged by the Province of Ontario on
accounts receivable.
31 The Organization shall pay the amount demanded by cheque, made payable to
the "Minister of Finance", and mailed to the Ministry to the attention of the
Manager, Interdisciplinary Practitioner Program.
Acknowledgement
32. The Organization shall acknowledge the support of the Government in all publicly
distributed reports and materials and in all advertising and publicity relating to the
Program, in a format approved by the Ministry.
Notices
33. Any notice, consent, approval or other communication required, permitted or
contemplated to be given under this Agreement shall be in writing and shall be
delivered personally or by courier, sent by certified, registered or postage prepaid
mail, or sent by facsimile, addressed to the other party at the address provided
below or at such other address as either party shall later communicate to the
other in writing in the manner provided by this section 33. All notices, consents,
approvals and other communications shall be addressed as follows:
To the Ministry:
Interdisciplinary Practitioner Program
Primary Health Care Team
80 Queen Street, 3rd Floor
Kingston ON K7K 6W7
Attention: A/Manager, East and Interdisciplinary
Phone: (613) 650-5444
Fax: (613) 650-5440
To the Organization:
Municipality of Bayham
9344 Plank Road
Straffordville, ON NOJ 1Y0
Attention: Margaret Underhill
Planning Coordinator/Deputy Clerk
Phone: (519) 866-5521
Fax: (519) 866-3884
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Municipality of Bavham
34. Ail notices, consents, approvals and other communications shall be effective and
deemed to have been received:
(a) at the time the delivery is made when the communication is delivered
personally or by courier;
(b) seventy-two (72) hours after deposit in the mail when the communication
is sent by certified, registered or postage prepaid mail; or
(c) at the time the facsimile is received when the communication is delivered
by facsimile.
Schedules
35. The following schedules are attached to this letter and form part of the
Agreement:
(a) Schedule "A" —Terms of agreement between Nurse Practitioner and
Collaborating Physician;
(b) Schedule "B" — Budget;
(c) Schedule "C" -- Financial Reports;
(d) Schedule "D" — Performance Reports;
(e) Schedule "E" — Grow Your Own Nurse Practitioner Agreement; and
(f) Schedule "F" — Return of Service Agreement.
Survival
36. Sections 11, 12, 13, 14, 15, 16 (to the extent any report has not been submitted
in accordance with section 16), 18, 27, 28, 29, 30, 31, 36 and 38 shall survive
termination or expiry of this Agreement for a period of 7 years from its termination
or expiry.
Entire Agreement
37. This Agreement together with the attached schedules listed in section 35
constitutes the entire agreement between the parties hereto with respect to the
subject matter contained in this Agreement and supersedes all prior oral or
written representations, agreements and understandings.
EIgi104 GYO PCNP
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Municipality of Bavham
Riqhts and Remedies Cumulative
38. Except to the extent otherwise expressly stated in this Agreement, the rights and
remedies of the parties are cumulative and are in addition to, and not in
substitution for, any rights and remedies provided under any other agreement, at
law or in equity.
Please acknowledge your acceptance of the terms and conditions of this Agreement, by
signing both copies of this letter and returning them to the Ministry address identified in
section 33 of this Agreement.
Yours sincerely,
_zhilcAde/j/
Laura Pinkney
A/Manager, East and Interdisciplinary
On behalf of and with the authority of the Municipality of Bayham, I hereby accept the
terms and conditions described above.
Au hori . Signing Officer for the Municipltlity of Bayham
t $
Dates
/7azi-Y/Aleie;e:,
Witne
5-/5r,
Dat
Authorized Signing Officer for the Municipality of Bayham
to
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Wit,-ss
Elgi 1 D4 GYO PCNP
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Schedule "A"
Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and
the Municipality of Bayham dated the day of 2008.
Terms of Agreement between the Nurse Practitioner and the Collaborating Physician
The agreement the Municipality of Baybam enters into with the Collaborating Physician(s) shall include
clauses:
(a) providing that the Collaborating Physician(s) shall provide ongoing professional support to the
Nurse Practitioner to enable the Nurse Practitioner to meet the Nurse Practitioner's professional
obligations as described in the Standards for Consultation with Physicians by RN(EC)s, issued
by the CNO;
(b) warranting that the Nurse Practitioner and the Collaborating Physician(s)have established a
collaborative working relationship that allows the Nurse Practitioner to provide the Services and
to meet the Nurse Practitioner's professional responsibilities as prescribed by law;
(c) warranting that the Collaborating Physician(s) is a member in good standing of the College of
Physicians and Surgeons of Ontario;
(d) warranting that the Collaborating Physician(s) has and shall maintain for the period during
which the Collaborating Physician(s) is engaged by the Municipality of Bayham to provide
support to the Nurse Practitioner,membership in the Canadian Medical Protective Association or
its equivalent; and
(e) providing any other terms necessary to give effect to the obligations of the Collaborating
Physician(s) described above.
EIgi104 Schedule A
Attachment(I)
Municipality of Bayham
Summary GYO NP Funding
For the Period
September 1,2006 to October 31,2007
(1) (2) (3) (4) (5)
Approved Approved RN Interim Total Total
Budget Budget Funding t April 1,2007 September 1,2006
September 1,2006 April 1,2007 1 September 1,2007 To To
To To To October 31,2007 October 31,2007
March 31,2007 August 31,2007 October 31,2007
(7 Months) (5 Months) (2 Months) (2+3) 0+4)
1
(i) RN Sala Fundin: $ 30,948 $ 22,105 1 $ 8,842 $ 30,947 $ 61,895
(ii) Benefits @ 26% 8,050 5,750 1 2,300 i 8,050 16,100
(iii) RN Education Funding(Tuition+Expenses)2 - 11,500 1 - I 11,500 $ 11,500
(,s,) Total tpproved. Funding $ 38,998 $ 39,355 jr$ 11,142 $ 50,497 $ 89,495
(,) Mit P • _ \.N, ,_t; $ '
I RN Interim Funding September&October 2007 - RN Salary&Benefits: Annual Salary$53,053 (2 months @$4,421/each plus benefits @$1,150/each)
Z RN Education Funding-approved one-time funding of$10,364(Tuition @$3,502 plus Other Education Costs @ $6,862)deposited November 30,2007.
Elgi 104 GYO NP 2007_08 Budget Template
GYO NP Funding
Attachment(H)
Municipality of Bayham
Primary Care Nurse Practitioner Funding Request
2007-08
Expenditure Categories Annual Funding
Request
(i) NP Salary $ 85,320
(ii) Benefits 26% 22,184
(iii) Overhead Expenses 9,146
(iv) Total Annual Funding $ 116,650
' Primary Care Nurse Practitioner Funding Allocation
Maximum funding allocation of$116,650 and is to provide for each NP salary and benefit costs, and a portion of overhead expenses. Any additional
costs beyond the maximum allocation of$116,650 will need to be planned for by the organization.
. Nurse Practitioner maximum annual salary funding level of$85,320.
. Benefits inclusive of statutory employee benefits(e.g. CPP,El,etc)
. Overhead Expenses exclusive of funding contribution(s) and/or in kind resources received from community and or/organization.
2
Nurse Practitioner Date of Hire -November 1, 2007
Elgi104 GYO NP 2007_08 Budget Template
0708 Budget Request
Schedule"B"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of
Budget
For the Fiscal Period
November 1,2007 to March 31,2008
Maximum Approved
Expenditure Categories Annual Budget
Funding November 1,2007
Allocation To
March 31,2008
(i} NP Salary $ 85,320 $ 35,550
(ii) Benefits 26% 22,184 9,243
(iii) Overhead Expenses 9,146 3,811
(iv) Total Approved Funding 1 $ 116,650 $ 48,604
(v) nal,;Monthly Pa meut
0 i) Subsequent Monthly Payments 3. $ - 9,721 9,721
1 Maximum annual funding allocation of$116,650 to provide for each NP salary and benefit costs,and a portion of overhead expenses. Any additional costs will need
to be planned for by the organization.
NP Salary-to a maximum annual of$85,320.
.Benefits-inclusive of statutory employer contributions(e.g.CPP,El,etc.)
2 First Monthly Payment-retroactive funding of$19,422 owing for the period November 1,2007 to December 31,2007 to be deposited in conjunction with the
January 31,2008 monthly payment of$9,721 for a total deposit of$29,163.
3 Subsequent monthly payments to be deposited in the amount of$9,721 unless otherwise notified.
EIgi104 GYO NP 2007_08 Budget Template
0708 Approved Budget
Schedule"C"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of
Financial Report
For the Fiscal Period
November 1,2007 to March 31,2008
MOHLTC Expenditures'
Approved (t) i (2) (3) (4) (5)
Budget 1st Quarter j 2nd Quarter i 3rd Quarter Ath Quarter Total
Expenditure Categories November 1,2007 Apr 1-Jun 30 i Jul 1-Sep 30 1Nov 1-Dec 31 ! Jan 1-Mar 31 November 1,2007
To Due Due I Due I Due To
March 31,2008 July 31,2007 I October 31,2007 I January 31,2008 1 April 30,2008 March 31,2008
t ! I [I+2+3+4)
Expenditures: t a/a ! n/a I
(i) NP Salary $ 35,550 I I ! $ -
(ii) Benefits 26% 9,243 I I
(iii) Overhead Expenses 3,811 1 ! i -
_Total Expenditures $ 48,604 $ - 1$ - i$ _ - i $_ -_$ -
t Expenditures-report actual expenditures that are related to Ministry funding only. In Kind Funding Contribution(s)and/or resources received from the community and/or organization are to he separately
identified and reported in the section below.
-1In Bind Cand rbntron(s)-1tkt type t i, '� I ! Q !
1st Quarier 2nd Qaarter ! 3rd uuter I 4th Quarter Total
! I
(u) I : I -
Sul) : E !
I E -
(a") i i -
i I
(v,) ) I I i -
(vu) j, I
i I I
(flirt ! -
I
I
7otwlInBundConn nbntrons I$ - i$ - '� _ - I $ - $ -
1 In Kind Contributions-identify and report funding contribution(s)and/or in kind resources received from the community and/or sponsoring organization.
Please complete the above information and submit in accordance with the due date to:
Ministry of Health and Long-Term Care
Interdisciplinary Practitioner Program,Primary Health Care Team
80 Queen Street,3rd Floor
Kingston ON K7K 6W7
Approved By: Dated:
Elgi104 GYO NP 2007_08 Budget Template
Sched C Fin Rep
Schedule"D"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Baybam dated the of
Performance Report
For The Fiscal Period
November 1,2007 to March 31,2008
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total
Apr 1-Jun 30 Jul 1-Sep 30 Nov 1-Dec 31 Jan 1-Mar 31 November 1,2007
Due Due Due Due To
July 31,2007 October 31,2007 January 31,2008 April 30,2008 March 31,2008
(a) Patient Encounter n/a n/a
E.Number of patients encountered in clinic/reg hours -
.Number seen in extended hours/or on call -
.Number seen outside of clinic(eg Home,LTC,hospital) -
.Patient phone calls>5 mins -
(b) Disease Prevention Strategies
(i)Immunizations(exclusive of injections):
.Routine childhood at 18 mo or before
I.Routine childhood at age 4 or over -
.Influenza -
.Tetanus -
.Pneumovax -
.Other(hepatitis A/B vaccine) -
.Other
.Other
.Other _ -
.Other _ -
(ii)Screening:
Routine prenatal care with antenatal screening(II/S,GTT) -
.HD-Heart Disease(using CMAJ guidelines) -
.DM-Diabetes Mellitus(CMAI guidelines) -
.BC-Breast Cancer(clinical exam and/or screening mammn) _ -
.CC-Colo/rectal Cancer(Hemoccult testing) -
.PAP -Cervical CA Screen(Pap) -
.STD-Sexually Transmitted Diseases(swabs) -
.Osteoporosis(hi-risk questionnare BMD) -
.Mental Health screen(depression,dementia) -
.Infectious Diseases(TB testing,rubella.VDRL,HIV) -
.Well Baby/Child(Rourke Screening Tool) -
Other e.g.domestic abuse,CAGE screening for ETOH abuse -
.Other e.g pre-op assessment -
.Other - -
.Other -
.Other _ -
.Other
E1gi104 GYO NP 2007_08 Budget Template
Sched D Performance
Schedule"D"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of
Performance Report
For The Fiscal Period
November 1,2007 to March 31,2008
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total
Apr 1-Jun 30 Jul 1-Sep 30 Nov 1-Dec 31 Jan 1-Mar 31 November 1,2007
Due Due Due Due To
July 31,2007 October 31,2007 January 31,2008 April 30,2008 March 31,2008
(c) Curative Care,diagnoses and Tx
.Acute episodic minor illness -
Acute/episodic minor injury(e.g.suturing,removal of FB) -
.Acute/complex major illness -
.Major injury -
.Abnormal finding requiring follow up -
.Other procedures(e.g.Allergey shot,B12,etc.) -
(d) Rehabrlitative Care
.Initial visit or tx of a chronic disease -
Adjustment of tx for a chronic disease -
.Monitoring of a stable chronic illness -
.Injury: Ongoing Care(e.g.bum dressings,wound care,etc.) -
.Disability:Ongoing Care
.Other -
(e) Supportive Care
.Education or promotion of self-care -
.Advocacy -
.Counselling(e.g.contraception/smoking cessation) -
.Palliative care -
.Coordinate/link to community /social services/navigation -
(f) Consultations/Referrata
Number of consultations with GP/FP -
Number of referrals from GP/FPs -
Number of referrals from other Health Care Professionals _ -
Number of referrals to GP/FPs _ -
Number of referrals to Other Medical Professionals -
Number of referrals to Rehab Professionals(OT,PT,etc.) _ -
Number of referrals to Social Worker -
Number of referrals to Dietician -
Number of referrals to Mental Health Professionals
Number of referrals to Emergency Department -
Number of referrals to Other -
Please refer to the Tip Sheet-Completing Schedule"D"Performance Report for guidelines on how to complete the above information. Please submit in accordance with the due date to:
Ministry of Health and Long-Term Care
Interdisciplinary Practitioner Program,Primary Health Care Team
80 Queen Street,3rd Floor,Kingston ON K7K 6W7
Approved By: Dated:
Elgi 104 GYO NP 2007_08 Budget Template
Soiled D Performance
Schedule"D"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the Alf
Performance Report
For The Fiscal Period
November 1,2007 to March 31,200S
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
(g) Workshops/Seminars provided to patientc/tommwaities(List date topic and number of attendees) Apr 1-Jun 30 Jul 1-Sep 30 Oct 1-Dec 31 Jan 1-Mar 31
(QI) 1st Quarter:
n/a
(Q2) 2nd Quarter:
n/a
E1gi104 GYO NP 2007_0$Budget Template
Schedule D Workshop
Schedule"D"
Attached to and forming part of the Agreement between the Ministry of Health and Long-Term Care and the Municipality of Bayham dated the of
Performance Report
For The Fiscal Period
November 1,2007 to March 31,2008
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
(g) Workshops/Seminars provided to patients/communities(list date,topic and number of attendees; Apr 1-Jun 30 Jul 1-Sep 30 Oct 1-Dec 31 Jan 1-Mar 31
(Q3) 3rd Quarter.
(Q4) 4th Quarter:
Please refer to the Tip Sheet-Completing Schedule D"Performance Report"for guidelines on how to complete the above information and submit in accordance with the due date to:
Ministry of Health and Long-Term Care
Interdisciplinar;Practitioner Program,Primary Health Care Team
80 Queen Street,3rd Floor,Kingston ON 1C7K 6W7
Approved By: Dated:
Elgi 104 GYO NP 2007_08 Budget Template
Schedule D Workshop
Schedule "E"
Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and
the Municipality of Bayham dated the day of 2008.
Grow Your Own Nurse Practitioner Agreement
Eigi104 Schedule E
Schedule "F"
Attached to and forming part of the agreement between the Ministry of Health and Long-Term Care and
the Municipality of Bayham dated the day of 2008.
Return of Service Agreement
Elgi104 Schedule F